Who May Make a Request
Your prescriber may ask us for a coverage determination on your behalf. If you want another individual (such as a family member or friend) to make a request for you, that individual must be your representative. Contact Us to learn how to name a representative.
You may also ask us for a coverage determination by phone at 1-888-550-5252.
- Printable Form: Request for Medicare Prescription Drug Determination (PDF).
- This form may be sent to us by mail or fax:
- Wellcare Health Plans
P.O. Box 31397
Tampa, FL 33631 - Fax: 1-866-388-1767
- Wellcare Health Plans
